The largest Wholesale distributor for dollar store products and general merchandise!

Enterprises, Inc.

(323)CONCORD

(800)960-0896

(323)588-8888

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   Apparel,accessories
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Credit Card Authorization Form:

Fill in the form, Print it, Sign and Fax it to (323) 588-8080

First & Last Name:
Company Name:
Account Number:
Invoice Number:
Fax:
Date:
City:
State:
Zip Code:
Phone:
Driver's License #:
Expiration Date:
Date of Birth:
Payment Method:	Credit Card Visa MasterCard Discover
Credit Card #:
Expiration Date:
Total Amount:
I _______________________________________________hereby authorized CONCORD ENTERPRISES INC., to charge my credit card for purchasing general merchandise or applying towards on my account . CARDHOLDER'S NAME First Name__________________ Last Name__________________ CARDHOLDER'S MAILING ADDRESSES ________________________________________________________
Credit Card Holder's Signiture	___________________
Date	___/___/___

Address: 2957 E. 46 ST. Los Angeles, California 90058 U.S.A. Tel(323)588-8888 (323)CONCORD Fax(323)588-8080
Tol Free(800)960-0896
Email: sales@dollaritem.com
Â© 1982 Concord Enterprises, Inc. All rights reserved.